stolyar wrote:
Project CR Butler:Day 21:Critical Reasoning (CR2)
For all CR butler Questions Click HereLists of hospitals have been compiled showing which hospitals have patient death rates exceeding the national average. The data have been adjusted to allow for differences in the ages of patients.
Each of the following, if true, provides a good logical ground for hospitals to object to interpreting rank on these lists as one of the indices of the quality of hospital care EXCEPT:
(A) Rank order might indicate insignificant differences, rather than large differences, in numbers of patient deaths.
(B) Hospitals that keep patients longer are likely to have higher death rates than those that discharge patients earlier but do not record deaths of patients at home after discharge.
(C) Patients who are very old on admission to a hospital are less likely than younger patients to survive the same types of illnesses or surgical procedures.
(D) Some hospitals serve a larger proportion of low-income patients, who tend to be more seriously ill when admitted to a hospital.
(E) For-profit hospitals sometimes do not provide intensive-care units and other expensive services for very sick patients but refer or transfer such patients to other hospitals.
Lists of hospitals with patient death rates exceeding national avg have been created. The data is adjusted for ages of patients (i.e hospitals catering to older patients are expected to have higher death rates so the data is adjusted accordingly)
The hospitals do not want the rank on these lists to be a measure of quality of hospital care. Each option except one gives a logical reason for hospitals' opposition.
(A) Rank order might indicate insignificant differences, rather than large differences, in numbers of patient deaths.
What if differences are minor such as 10.056 per 1000 and 10.1 per 1000 but they differ by 100 in their rank? The difference may be considered insignificant in number terms but in rank terms it makes one hospital look far worse than the other.
(B) Hospitals that keep patients longer are likely to have higher death rates than those that discharge patients earlier but do not record deaths of patients at home after discharge.
Certainly a valid point. Hospitals who give care longer to the patient will have higher death rates than hospitals who send patients away quickly and then not record their death. Hence death rate may not be good measure of the care the hospital provides.
(C) Patients who are very old on admission to a hospital are less likely than younger patients to survive the same types of illnesses or surgical procedures.
The data has already been adjusted for age differences. Hence the hospitals cannot complain about this and this is not a logical point.
Hence this is the answer.
(D) Some hospitals serve a larger proportion of low-income patients, who tend to be more seriously ill when admitted to a hospital.
A valid point again. If patients coming in are more seriously ill, the death rates are expected to be higher so the hospital should not be penalised for that.
(E) For-profit hospitals sometimes do not provide intensive-care units and other expensive services for very sick patients but refer or transfer such patients to other hospitals.
Some hospitals do not provide services to very sick patients but refer them to other (perhaps specialised) hospitals. The death rate in these hospitals will be lower than the death rate in other hospitals. If they treat only the easily treatable cases, they are bound to have better standing in death rates. Hence (E) is a valid concern against the lists too.
Answer (C)
What does it mean when option E tells FOR-profit hospitals don't provide IC units and other expensive services??? If they have specialised system why are they referring to other hospitals??
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43% (02:15) correct 
